This Guardian UK Special Report looks at the alarming increase of bacteria resistant to all known antibiotics and the dearth of new antibiotics in the drug development pipeline. One reason cited for this dearth is the economics of antibiotics with many short duration courses.

Atul Gawande, of the Checklist Manifesto fame, examines the complex nature of end-of-life care in the New Yorker Magazine. With the backdrop of the death panel talk that arose from the United States Healthcare Reform legislative battle, Gawande chooses to examine end-of-life decisions from the perspective of the patient and their families and not the cost implications.

It is amazing that we are almost 3 years old and we are still ticking. As we continue to grow we decided to move to a more permanent home. In that process we also decided to re-brand as our scope has also grown. We are now at a new domain with a new name – Global Health Ideas (globalhealthideas.org). I’ll post more details shortly, in the meantime please join us at the new site and excuse the temporary dust up over the next week as we transition the blog over. Thanks!

But one thing remains true: “People have a very weird perception of large numbers,” [Dr. Brockmann] said. “If you have 2,000 cases of flu in a country of 300 million, most people think they’re going to be one of the 2,000, not one of the 299,998,000.”

Ok, but what about the facts? The fast moving breaking news often plays fast and loose with the truth, and can spread alarming information. Early reports of the swine flu in Mexico seemed to have extremely high mortality reports, especially among young adults. Now, with new evidence of confirmed cases, the virus is looking alot milder. When I first read that influenza virus could survive for 10 days on money, I thought it was another casualty of the truth, as the avian-human-swine flu reported in a press briefing by the CDC. However, in this case, the facts seem to check out (Survival of Influenza Virus on Banknotes, Thomas et al), unlike the potluck origins of the swine flu which ProMED reported to be, upon closer examination – just swine flu.

Thermal scanners purchased after the SARS outbreak have been mobilized for border screening. Super-cool, but do they work to stop the spread of an epidemic?

The New York Times led with this image, but now the story link has been updated. Here’s the original text by Donald G. McNeil, Jr. on border controls:

Given extensive human-to-human transmission, the World Health Organization raised its global pandemic flu alert level on Monday, but it recommended that borders not be closed nor travel bans imposed, noting that that the virus had already spread and that infected travelers might now show any symptoms.

However, many countries are tightening border and immigration controls, and on Tuesday Britain advised against any nonessential travel to Mexico. Japan announced that it would no longer allow Mexican travelers to obtain visas upon arrival. The United States, France and Germany have also warned against nonessential travel to Mexico.

Here’s my understanding of how it works: the thermal scanner camera detects infrared radiation (IR). Basically any object emits IR which intensifies as it gets hotter. The camera has a sensor which detects IR and converts it into a temperature reading. In this system it does it visually.

However, when you first get flu, you don’t have a temperature, and the thermal scanner only measures skin temperature on your face, so an early fever (which raises your core temperature) is also not detectable.

On another note, I’m wondering why journalists don’t seem to have quick access to infectious disease specialists. In the New York Times, an environmental health epidemiologist is quoted in the debate, and here in the Cape Times, a sociologist who now specializes in the public understanding of biology. Where are the infectious disease experts? Maybe the CDC needs to draw up a list of media contacts among their top virologists and infectious disease specialists. Maybe part of science education should be a course in writing on science for the public, as well as how to write (and read!) papers.

Swine flu is in. In the rush to cover this latest possible pandemic, newswires are alive with activity, blogs and social networking sites are buzzing, and the CDC and WHO are back in the limelight. This despite the fact that the number of cases are limited (only 40 confirmed infections have occurred in the US).

This rush was started by Google Flu Trends, a website that tracks flu-related search queries to estimate influenza levels in different US states. Further studies suggested the same approach might work for other diseases as well.

Analyzing Google Trends

So how has Google Trends, the broader application of the Flu Trends concept, performed in the current scenario? A quick analysis shows that Google search results did in fact increase over the past few days (see chart – source: Google Trends).

A quick analysis shows three items worth mentioning:

First, while Google Trends does show an increase in search activity on “swine flu,” the first uptick in activity only occurred on April 23. By contrast, the first news stories appeared on April 21 when two cases were confirmed in California.

Second, Google Trends reports that the majority of search queries were from New Zealand, USA, UK, Canada, and Australia. Only a very small minority were from Mexico. Yet, Mexico is the country supposedly at the heart of the pandemic.

Explaining the Discrepencies

I had used a Google Trends like methodology two years ago to track the evolution of climate change as an issue in news coverage. Having worked on that, I can propose a few general reasons that explain why Google Trends is limited in this case.

First, it appears that Google Trends follows with some time lag, actual infections. This should not be surprising, as people are not likely to search for a disease before having had some exposure to it. This does not mean that it is not a useful tool for tracking diseases over the long term. At the very least, the response time of a system based on GT might be lower.

Second, the current scenario shows that Google Trends is highly susceptible to “noise.” Prior to this outbreak, swine flu was probably not a commonly known disease, and queries on it were extremely rare (if not non-existent). Thus, even the slightest uptick in search activity would show up as a major change. That uptick was provided by the highly charged media coverage of the subject. Given this, one wonders if the search results are more “noise” and less people with a genuine interest in the subject. So, Google Trends is likely to be more accurate where general knowledge of a subject (the baseline) is high, and media coverage (noise) is low.

Finally, and most interestingly, why is it that most of the search results came from the US, while Mexico is more exposed to it? Not surprisingly, this methodology only works where both a large number of the population and media are on the internet.

What Next for Google Trends?

When discussing why most search queries occurred in the US, it is worth noting another fact about the swine flu outbreak – that it has traveled extremely fast. Originating in Mexico, it has been carried to the USA, Spain, and New Zealand. This brings into question the validity of using the geographic source of search queries as a reliable indicator of where the disease actually is.

Still, it may also offer a way to enhance Google Trends. What if Google Trends data was combined with travel data on the number of people traveling from a “hotspot” of an infectious disease. It would be logical to assume that popular destinations, or ones which receive travel groups, would be the most likely next locations for further infections. Thus, a map could potentially be created of not only where the disease is generating interest, but where it might be headed.

Of course, Google does not have access to such data – though at some point it may decide to acquire a travel operator. But the general lesson is simply that to make Google Trends more useful, search query data needs to be looked at together with real-world data (such as travel data or hospital records).

It is still early days for the swine flu outbreak, but somecommentators are already suggesting the “social web” has actually created hysteria rather than help track the disease. That may be true, but it is hardly a problem of the “social web.” As a reader on the FP pointed out, “Twitter is only a natural extension of a typical neighborhood.”

So, in this “typical neighborhood,” what the swine flu outbreak has done is illustrate where Google Trends does well – in tracking general interest amongst heavy Internet users. But it also exposes limitations – the methodology is (not surprisingly) susceptibility to “noise” from media coverage and is biased towards countries and issues that are online. This does not mean that the idea itself is flawed. Just that it must be taken with a pinch of salt, and that it needs work – especially interfacing it with real-world data streams – to make it really useful.

How one communicates a message is critical to what you are trying to accomplish. It amazes me how little upfront investment some organizations/campaigns put into this kind of thing. This recently came to mind when I saw the work of Toby Ng, who has “used information graphics to re-tell the story in another creative way” with the commonly used theme – if the world was 100 people then…Some examples below:
HT (The Atlantic)

Cautionary Note and CounterpointThe comment thread at Flowing Data suggests an alternate critical argument about using this technique because it is not a “serious attempt to convey information” and it is easy to distort data when you manipulate in such a manner. I am not a graphic design expert and I haven’t read Tufte but this is certainly a fundamental principle (don’t distort the data). Given this warning, this specific style is attractive and can be useful depending on the audience and the goals you have. There is a lot more that can be said on this theme and it would be great to have global health folks brainstorming different ways of communicating messages beyond doom and gloom.

For some inspiration and ideas check out sites like Flowing Data and Jaspal’s previously related post on “Why Bad Presentations Happen to Good Causes“. For audio visual storytelling the talk by Hans Rosling at TED 2006 is a global health classic that pushes us to be more creative story tellers. This has to be one of the best global health videos I have ever seen (which we posted 2 years ago):